Articles

Development and reliability of the histological THROMBEX-classification rule for thrombotic emboli of acute ischemic stroke patients

Thrombus histology has become a potential diagnostic tool for the etiology assessment of patients with ischemic stroke caused by embolic proximal vessel occlusion. We validated a classification rule that diffe...

Authors: Julika Ribbat-Idel, Florian Stellmacher, Florian Jann, Nicolas Kalms, Inke R. König, Marcus Ohlrich, Georg Royl, Stefan Klotz, Thomas Kurz, Andrè Kemmling and Florian C. Roessler

Isolated thalamic stroke – analysis of clinical characteristics and asymmetry of lesion distribution in a retrospective cohort study

More patients with left-hemispheric than right-hemispheric strokes are admitted to hospitals. This is due to the easier recognition of cortical symptoms of the dominant-hemisphere. The thalamus constitutes a “...

Authors: Martin A. Schaller-Paule, Ariane Martinez Oeckel, Jan-Rüdiger Schüre, Fee Keil, Elke Hattingen, Christian Foerch and Maximilian Rauch

Digital concepts in post-stroke care pathways: adding value and minimizing burden

Authors: Christoph Schöbel and Martin Köhrmann

The PostStroke-Manager – combining mobile, digital and sensor-based technology with personal assistance: protocol of the feasibility study

Post stroke management has moved into the focus as it represents the only way to secure acute treatment effects in the long term. Due to individual courses, post stroke management appears rather challenging an...

Authors: Dominik Michalski, Alexander Prost, Till Handel, Max Schreiber, Jean-Baptiste Tylcz, Daniela Geisler, Daniela Urban, Stephanie Schramm, Stefan Lippmann, Jenny Gullnick, Thomas Neumuth, Joseph Classen and Galina Ivanova

Neuroradiological emergency consultations during the first year of the COVID-19 pandemic

Measures taking aim at minimizing the risk of coronavirus transmission and fear of infection may affect decisions to seek care for other medical emergency conditions. The purpose of this analysis was to analyz...

Authors: Johannes A. R. Pfaff, Marcial E. Harlan, Günter Pfaff, Alexander Hubert and Martin Bendszus

Profiles of patients’ self-reported health after acute stroke

We aimed to identify groups of patients with similar health status after stroke, assessed by patient reported outcome measures (PROMs), to improve initial risk stratification.

Authors: D. Leander Rimmele, Theresa Schrage, Lisa Lebherz, Levente Kriston, Christian Gerloff, Martin Härter and Götz Thomalla

Multiple sclerosis is not associated with an increased risk for severe COVID-19: a nationwide retrospective cross-sectional study from Germany

Since the coronavirus disease 2019 (COVID-19) has risen, several risk factors have been identified, predicting a worse outcome. It has been speculated that patients with Multiple sclerosis (MS) have an increas...

Authors: Daniel Richter, Simon Faissner, Dirk Bartig, Lars Tönges, Kerstin Hellwig, Ilya Ayzenberg, Christos Krogias and Ralf Gold

Factors influencing the detection of treatable epileptogenic lesions on MRI. A randomized prospective study

To prospectively analyze factors associated with detecting epileptogenic lesions on MRI within the work-sharing process of neurologists, epileptologists, radiologists and neuroradiologists.

Authors: Tim Wehner, Philippe Weckesser, Steven Schulz, Annika Kowoll, Sebastian Fischer, Jessica Bosch, Leonie Weinhold, Rolf Fimmers, Matthias Schmid and Jörg Wellmer

No consensus about consensus?

Authors: Ludwig Kappos

Controversy on the treatment of multiple sclerosis and related disorders: positional statement of the expert panel in charge of the 2021 DGN Guideline on diagnosis and treatment of multiple sclerosis, neuromyelitis optica spectrum diseases and MOG-IgG-associated disorders

Authors: A. Bayas, A. Berthele, B. Hemmer, C. Warnke and B. Wildemann

Multiple sclerosis therapy consensus group (MSTCG): answers to the discussion questions

Authors: Heinz Wiendl, Ralf Gold and Frauke Zipp

Quality assurance data for regional drip-and-ship strategies- gearing up the transfer process

Stroke patients with large vessel occlusion (LVO) require endovascular therapy (EVT) provided by comprehensive stroke centers (CSC). One strategy to achieve fast stroke symptom ‘onset to treatment’ times (OTT)...

Authors: Erendira G. Boss, Ferdinand O. Bohmann, Björn Misselwitz, Manfred Kaps, Tobias Neumann-Haefelin, Waltraud Pfeilschifter and Natalia Kurka

Neurological manifestations of COVID-19 – an approach to categories of pathology

Various neurological manifestations of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported, associated with a broad spectrum of diverse neurological symptoms and synd...

Authors: Yana Leven and Julian Bösel

Simulation-based training improves patient safety climate in acute stroke care (STREAM)

Treatment of acute stroke performed by a multiprofessional, interdisciplinary team is highly time dependent. Interface problems are preprogrammed and pitfalls relevant to patient safety are omnipresent. The Sa...

Authors: Ferdinand O. Bohmann, Joachim Guenther, Katharina Gruber, Tanja Manser, Helmuth Steinmetz and Waltraud Pfeilschifter

Chromium and cobalt intoxication mimicking mitochondriopathy

A 53-year old male with a history of progressive visual impairment, hearing loss, peripheral neuropathy, poorly controlled diabetes mellitus, cardiomyopathy, and weight loss was referred to the rare disease ce...

Authors: Tim W. Rattay, Torsten Kluba and Ludger Schöls

Better be prepared: the spectrum of neuropsychiatric impairment among Libyan war victims transferred to Germany for trauma rehabilitation

The current Libyan civil war has originated many casualties, imposing medical challenges. War injuries are complex, requiring specialized knowledge and interdisciplinary assessment for adequate patient and int...

Authors: Felix Dootz, Otto-Magnus von Stackelberg, Joan Abaya, Christian Jacobi, Christoph Mohs, Eva Maria Craemer, Christoph Rangger, Uta Meyding-Lamadé and Eva Kathrin Lamadé

Quality of life and its predictors in adults with tuberous sclerosis complex (TSC): a multicentre cohort study from Germany

Tuberous sclerosis complex (TSC) is a monogenetic, multisystemic disease characterised by the formation of benign tumours that can affect almost all organs, caused by pathogenic variations in TSC1 or TSC2. In thi...

Authors: Johann Philipp Zöllner, Nadine Conradi, Matthias Sauter, Markus Knuf, Susanne Knake, Gerhard Kurlemann, Thomas Mayer, Christoph Hertzberg, Astrid Bertsche, Ilka Immisch, Karl Martin Klein, Klaus Marquard, Sascha Meyer, Anna H. Noda, Felix von Podewils, Hannah Schäfer…

Persistent cognitive impairment associated with cerebrospinal fluid anti-SARS-CoV-2 antibodies six months after mild COVID-19

Neurological long-term sequelae are increasingly considered an important challenge in the recent COVID-19 pandemic. However, most evidence for neurological symptoms after SARS-CoV-2 infection and central nervo...

Authors: Max Borsche, Dirk Reichel, Anja Fellbrich, Anne S. Lixenfeld, Johann Rahmöller, Eva-Juliane Vollstedt, Bandik Föh, Alexander Balck, Christine Klein, Marc Ehlers and Andreas Moser

Optic disc drusen mimicking Idiopathic Intracranial Hypertension (IIH): rely on ultrasound

Optic nerve ultrasound is an established routine supplementary diagnostic tool for idiopathic intracranial pressure but it can also be helpful in avoiding misdiagnoses. We describe a case of an obese 15- year-...

Authors: Eleni Bakola, Dimitrios Alonistiotis, Chryssa Arvaniti, Stavroula Salakou, Niki Nana, Aikaterini Foska, Vasiliki Kotsali-Peteinelli, Konstantinos Voumvourakis and Georgios Tsivgoulis

Letter to the Editor: Analysis of stroke patient migration for mechanical thrombectomy and changes in neurointerventional center size in Germany

To analyse nationwide changes in neurointerventional center size of all German hospitals performing mechanical thrombectomy (MT) in stroke patients from 2016 to 2019. Furthermore, we assessed cross-district pa...

Authors: Ralph Weber, Dirk Bartig, Christos Krogias, Daniel Richter, Werner Hacke and Jens Eyding

Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice

The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whe...

Authors: Stefanie Behnke, Thomas Schlechtriemen, Andreas Binder, Monika Bachhuber, Mark Becker, Benedikt Trauth, Martin Lesmeister, Elmar Spüntrup, Silke Walter, Lukas Hoor, Andreas Ragoschke-Schumm, Fatma Merzou, Luca Tarantini, Thomas Bertsch, Jürgen Guldner, Achim Magull-Seltenreich…

Sensory trick effect in craniofacial dystonia as one of the possible impacts of wearing face masks during the COVID-19 pandemic

The report of a patient with blepharospasm during the COVID-19 pandemic suggested a potential ameliorating effect of wearing a face mask.

Authors: Frank Erbguth and Rüdiger Lange

Simultaneous paraneoplastic cerebellar degeneration, Lambert-Eaton syndrome and neuropathy associated with AGNA/anti-SOX1 and VGCC antibodies

Anti-glial nuclear antibody (AGNA) is an onconeuroal antibody targeting the nuclei of Bergmann glia in the cerebellum and Anti-SRY-related HMG-box 1 (SOX1). It is highly specific for small cell lung cancer (SC...

Authors: Jonas Feldheim, Cornelius Deuschl, Martin Glas, Christoph Kleinschnitz and Tim Hagenacker

N,N-Dimethylglycine in patients with progressive multiple sclerosis: result of a pilot double-blind, placebo, controlled randomized clinical trial

Oral administration of N,N-Dimethylglycine (DMG), a tertiary amino acid, presumably enhances oxygen utilization by tissue and complex with free radicals. Beneficial effects are improved endurance performance a...

Authors: Thomas Wolfsegger, Klaus Böck, Wolfgang Schimetta, Tim J. von Oertzen and Hamid Assar

Chronic intracranial hypertension after cerebral venous and sinus thrombosis – frequency and risk factors

Cerebral venous sinus thrombosis (CVST) can infrequently lead to chronical intracranial hypertension (IH) due to the altered venous drainage. The aim of this study was to ascertain the risk of IH after CVST an...

Authors: Christina Geisbüsch, Christian Herweh, Christoph Gumbinger, Peter A. Ringleb, Markus A. Möhlenbruch and Simon Nagel

Emergency intubation during thrombectomy for acute ischemic stroke in patients under primary procedural sedation

Emergency intubation is an inherent risk of procedural sedation regimens for endovascular treatment (EVT) of acute ischemic stroke. We aimed to characterize the subgroup of patients, who had to be emergently i...

Authors: Min Chen, Dorothea Kronsteiner, Johannes A. R. Pfaff, Simon Schieber, Martin Bendszus, Meinhard Kieser, Wolfgang Wick, Markus A. Möhlenbruch, Peter A. Ringleb, Julian Bösel and Silvia Schönenberger

Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients – a prospective evaluation

Removal of a tracheostomy tube in critically ill neurologic patients is a critical issue during intensive care treatment, particularly due to severe dysphagia and insufficient airway protection. The “Standardi...

Authors: Paul Muhle, Sonja Suntrup-Krueger, Karoline Burkardt, Sriramya Lapa, Mao Ogawa, Inga Claus, Bendix Labeit, Sigrid Ahring, Stephan Oelenberg, Tobias Warnecke and Rainer Dziewas

Treatment of progressive multiple sclerosis with high-dose all-trans retinoic acid – no clear evidence of positive disease modifying effects

All-trans retinoic acid (ATRA) is an acid derivative of vitamin A which is discussed as a promising candidate to ameliorate the disease course of multiple sclerosis (MS) by immunomodulation or even by promoting r...

Authors: Christoph Ruschil, Evelyn Dubois, Maria-Ioanna Stefanou, Markus Christian Kowarik, Ulf Ziemann, Marcus Schittenhelm, Markus Krumbholz and Felix Bischof

Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at ...

Authors: Rainer Dziewas, Hans-Dieter Allescher, Ilia Aroyo, Gudrun Bartolome, Ulrike Beilenhoff, Jörg Bohlender, Helga Breitbach-Snowdon, Klemens Fheodoroff, Jörg Glahn, Hans-Jürgen Heppner, Karl Hörmann, Christian Ledl, Christoph Lücking, Peter Pokieser, Joerg C. Schefold, Heidrun Schröter-Morasch…

Prognostication after intracerebral hemorrhage: a review

Approximately half of patients with spontaneous intracerebral hemorrhage (ICH) die within 1 year. Prognostication in this context is of great importance, to guide goals of care discussions, clinical decision-m...

Authors: Jens Witsch, Bob Siegerink, Christian H. Nolte, Maximilian Sprügel, Thorsten Steiner, Matthias Endres and Hagen B. Huttner

Mechanical thrombectomy in patients with cervical artery dissection and stroke in the anterior or posterior circulation – a multicenter analysis from the German Stroke Registry

Cervical artery dissection (CAD) is a rare cause of acute ischemic stroke (AIS) with large vessel occlusion (LVO) and may constitute a challenge for mechanical thrombectomy (MT). We compared procedural charact...

Authors: Ludwig Schlemm, Regina von Rennenberg, Eberhard Siebert, Georg Bohner, Fabian Flottmann, Gabor C. Petzold, Götz Thomalla, Matthias Endres and Christian H. Nolte

Stopping “transient ischemic attacks” by antiplatelet withdrawal

Transient ischemic attack (TIA) is considered to be an important risk factor for the development of ischemic stroke and requires complete etiopathogenic evaluation and prompt initiation of secondary prevention...

Authors: Lina Palaiodimou, Aikaterini Theodorou, Stefanos Lachanis, George P. Paraskevas, Matilda Papathanasiou, Christina Zompola, Konstantinos I. Voumvourakis and Georgios Tsivgoulis

Closure or medical therapy of patent foramen ovale in cryptogenic stroke: prospective case series

Results of randomized controlled trials (RCT) do not provide definite guidance for secondary prevention after ischemic stroke (IS)/transient ischemic attack (TIA) attributed to patent foramen ovale (PFO). No r...

Authors: Sven Poli, Elisabeth Siebert, Joshua Mbroh, Khouloud Poli, Markus Krumbholz, Annerose Mengel, Simon Greulich, Florian Härtig, Karin A. L. Müller, Wolfgang Bocksch, Meinrad Gawaz, Ulf Ziemann and Christine S. Zuern

Acute ischemic stroke care in Germany – further progress from 2016 to 2019

Stroke Unit Care (SUC), intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are evidence-based treatment options for acute ischemic stroke (AIS). Using nationwide comprehensive administrative data ...

Authors: Daniel Richter, Ralph Weber, Jens Eyding, Dirk Bartig, Björn Misselwitz, Armin Grau, Werner Hacke and Christos Krogias

Sudden paraparesis due to spinal cord ischemia with initial contrast enhancement of the cauda equina and time-delayed owl-eyes sign on follow-up MR imaging: a case report

We report on a case of a 52-year-old male with sudden paraparesis. The initial MRI showed contrast enhancement of the conus medullaris and the complete cauda equina. Follow-up MRI revealed a spinal ischemia in...

Authors: Benedict Breitling, Frederic Carsten Schmeel, Alexander Radbruch and Oliver Kaut

Consequences of COVID-19 pandemic lockdown on emergency and stroke care in a German tertiary stroke center

COVID-19 pandemic caused a decline in stroke care in several countries. The objective was to describe lockdown stroke care in a tertiary stroke center in Düsseldorf, Germany near Heinsberg, a German hot spot f...

Authors: Robin Jansen, John-Ih Lee, Bernd Turowski, Marius Kaschner, Julian Caspers, Michael Bernhard, Hans-Peter Hartung, Sebastian Jander, Tobias Ruck, Sven G. Meuth and Michael Gliem

Post-COVID-19 encephalomyelitis

Since the outbreak of coronavirus disease 2019 (COVID-19), a growing number of cases of acute transverse myelitis associated with COVID-19 have been reported. Here, we present the case of a patient who develop...

Authors: Ji-Won Kim, Nuran Abdullayev, Janina Neuneier, Gereon R. Fink and Helmar C. Lehmann

Neurological symptoms in COVID-19: a cross-sectional monocentric study of hospitalized patients

The SARS-Coronavirus-2 (SARS-CoV-2) invades the respiratory system, causing acute and sometimes severe pulmonary symptoms, but turned out to also act multisystematically with substantial impact on the brain. A...

Authors: Ummehan Ermis, Marcus Immanuel Rust, Julia Bungenberg, Ana Costa, Michael Dreher, Paul Balfanz, Gernot Marx, Martin Wiesmann, Kathrin Reetz, Simone C. Tauber and Jörg B. Schulz

Insomnia in neurological diseases

Insomnia is defined as difficulties of initiating and maintaining sleep, early awakening and poor subjective sleep quality despite adequate opportunity and circumstances for sleep with impairment of daytime pe...

Authors: Geert Mayer, Svenja Happe, Stefan Evers, Wiebke Hermann, Sabine Jansen, Ulf Kallweit, Maria-Lucia Muntean, Dieter Pöhlau, Dieter Riemann, Michael Saletu, Melanie Schichl, Wolfgang J. Schmitt, Friederike Sixel-Döring and Peter Young

SOP: treatment of delirium

Delirium is a frequent complication in hospitalised patients, often leading to difficulties in patient management and is associated with increased morbidity and mortality. Most patients in intensive care units...

Authors: Juraj Kukolja and Jens Kuhn

Variability of computed tomography angiography coverage of lung parenchyma in acute stroke

Computed tomography angiography (CTA) of the head and neck during acute ischemic stroke (AIS) usually includes visualization of lung apices. The possibility to evaluate for pulmonary changes, e.g. peripheral g...

Authors: Johannes A. R. Pfaff, Bianka Füssel, Marcial E. Harlan, Alexander Hubert and Martin Bendszus

COX2 expression is associated with preoperative tumor volume but not with volumetric tumor growth in vestibular schwannoma

Vestibular schwannomas (VS) are benign slow growing tumors arising from the vestibular nerve. The role of cyclooxygenase 2 (COX2) in tumor development of growth has been addressed in a few studies with contrad...

Authors: Felix Behling, Elisa Suhm, Vanessa Ries, Vítor Moura Gonçalves, Ghazaleh Tabatabai, Marcos Tatagiba and Jens Schittenhelm

Point-of-care testing for emergency assessment of coagulation in patients treated with direct oral anticoagulants including edoxaban

Direct oral anticoagulants (DOAC) including edoxaban are increasingly used for stroke prevention in atrial fibrillation. Despite treatment, annual stroke rate in these patients remains 1–2%. Rapid assessment o...

Authors: Florian Härtig, Ingvild Birschmann, Andreas Peter, Sebastian Hörber, Matthias Ebner, Matthias Sonnleitner, Charlotte Spencer, Paula Bombach, Maria-Ioanna Stefanou, Johannes Tünnerhoff, Annerose Mengel, Joachim Kuhn, Ulf Ziemann and Sven Poli

Effect of NEuroplasticity-Principles-based SEnsory-Rehabilitation (NEPSER) on sensori-motor recovery in stroke: study protocol for a randomized controlled trial

Up to 2/3rd of the stroke subjects may experience impairment in any of the somatosensory modalities such as light touch, proprioception, and stereognosis. The sensory recovery is strongly associated with the l...

Authors: Kamal Narayan Arya, Shanta Pandian, G. G. Agarwal, Neera Chaudhary and Akshay Kumar Joshi

Rationale and design of an interventional study of cross-sectoral, coordinated treatment of stroke patients with patient-orientated outcome measurement (StroCare)

Stroke has a long-term impact on functional status and quality of life in multiple health domains. A well-coordinated managed care program for stroke patients is crucial for ameliorating patients’ health and c...

Authors: David Leander Rimmele, Theresa Schrage, Christian Brettschneider, Alexander Engels, Christian Gerloff, Martin Härter, Michael Rosenkranz, Holger Schmidt, Levente Kriston and Götz Thomalla

Moral distress among residents in neurology: a pilot study

Medical progress, economization of healthcare systems, and scarcity of resources raise fundamental ethical issues. Physicians are exposed to increasing moral conflict situations, which may cause Moral Distress...

Authors: Hanna Hildesheim, Annette Rogge, Christoph Borzikowsky, Victoria Dorothea Witt, Eva Schäffer and Daniela Berg

Glymphatic system, AQP4, and their implications in Alzheimer’s disease

Lacking conventional lymphatic system, the central nervous system requires alternative clearance systems, such as the glymphatic system, which promotes clearance of interstitial solutes. Aquaporin-4 water chan...

Authors: Inês Silva, Jéssica Silva, Rita Ferreira and Diogo Trigo

Off-label intravenous thrombolysis for early recurrent brain embolism associated with aortic arch thrombus

Safety data of intravenous thrombolysis (IVT) in presence of aortic arch thrombus is scant. Furthermore, IVT is debatable in patients with prior recent stroke. We present a 51-year-old woman with recurrent maj...

Authors: Ioanna Koutroulou, Georgios Tsivgoulis, Vasileios Rafailidis, Elissavet Psoma, Konstantinos Kouskouras, Panagiotis Fotiadis, Nikolaos Grigoriadis and Theodoros Karapanayiotides

Neurological research and practice: the first milestone has been reached

Authors: Werner Hacke

SOP: emergency workup in patients with suspected acute bacterial meningitis

Despite antibiotic therapy, adjunctive treatment with dexamethasone, and care on modern intensive care units, bacterial meningitis remains a life-threatening disease with a high mortality and morbidity. One of...

Authors: Susanne Dyckhoff-Shen, Uwe Koedel, Hans-Walter Pfister and Matthias Klein